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远端稳定型股骨假体治疗青壮年股骨近端骨折合并不可逆转髋关节疾患疗效评估

Sepsis and Organ DysfunctionWT5”New Concept for Surviving Sepsis: from Phenomenon to Essence

  • 摘要: 目的 评估远端稳定生物型股骨柄治疗青壮年股骨近端骨折合并不可逆转髋关节疾患的临床疗效。方法 纳入15例股骨近端骨折合并不可逆转髋关节青壮年疾患(平均46.7岁,男6例,女9例),均用广泛微孔涂层远端稳定生物型股骨柄进行全髋关节置换。术后第1年1、3、6、12个月及第2年开始每年1次门诊随访,分别拍摄骨盆前后位,术侧股骨正侧位X线片,双下肢全长体层摄影。测量比较术后1月与末次随访股骨假体垂直下沉的距离。同时了解骨折愈合情况、假体固定情况、假体周围骨吸收情况。末次随访利用Harris评分系统评估患髋功能,分为优(90~100分)、良(80~89分)、中(70~79分)、差(70分以下)。结果 平均随访(45.5±21.7)月,股骨近端骨折平均在12.6周内愈合。末次随访和术后1月时的股骨假体下沉距离差异无统计学意义。末次随访术侧偏心距平均为35.8 mm,对侧为34.5 mm,两侧差异无统计学意义。Harris评分平均89.5分(范围86~97分)。1例在Gruen1区出现骨丢失。2例轻度跛行,1例发生大腿痛,1例发生膝关节前方疼痛。未见假体脱位,松动,感染。结论 广泛微孔涂层远端固定型股骨柄的生物型全髋关节置换治疗合并髋关节疾患的股骨近端骨折是一种较好的方法。这种方法既为骨折提供了良好的复位和初始稳定性,又同期解决了髋关节疾患,获得了良好的髋关节功能。

     

    Abstract: Objective To evaluate the clinical results of femoral proximal fracture with complex hip diseases using an uncemented extensively porous-coated long femoral stems.Methods 15 cases of femoral proximal fracture with complex hip diseases treated with the uncemented extensively porous-coated long femoral stem were retrospectively reviewed. All patients were followed up at 1,3,6,12 months in the first year postoperatively and once a year from the second year on.Radiological evaluations were conducted using the related criteria,including anteropostierior radiograph of pelvis,anteropostierior and lateral radiograph of proximal femur ,and flat tomography of lower limbs.The bone union of the femur fracture,the fixation of prosthesis,and periprosthetic bone loss were evaluated by above-mentioned radiography.The subsidence of femoral prosthesis was compared between 1 month postoperatively and the last follow-up. Complications during the follow-up period was recorded.Clinical outcomes were assessed with Harris Hip Score the last follow-up,including excellent (90-100),good (80-89),moderate (70-79) and bad (<70).Results The average follow-up period was (45.5±21.7) months. All fractures were united at mean 12.6 weeks. There were no femoral stem subsidence and evidence of loosening both radiologically and clinically. The reconstructive offset for femoral fracture was 35.8 mm, while the contralateral offset was 34.8 mm. The average Harris Hip Score was 89.5 at the last follow-up. Moreover, no loosening, dislocation or infection were observed. Conclusion Total hip arthroplasty with extensively porous-coated long femoral stem provides a good fracture stability that promotes fracture healing and offers a successful solution for femoral proximal fracture with complex hip diseases.

     

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